nothing Exclusions: Procedures and services to reverse a sterilization Substance Use Disorder Substance use disorder services including inpatient Hospital - Inpatient: After Deductible, Enrollee Residential Treatment; diagnostic evaluation and education; pays $150 Copayment per day up to $750 per organized individual and group counseling; and/or admission prescription drugs unless excluded under Sections IV. or V. Outpatient Services: After Deductible, Enrollee Substance use disorder means a substance-related or addictive pays $15 primary care provider services Copayment disorder listed in the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). For the Group Visits: No charge; Enrollee pays nothing purposes of this section, the definition of Medically Necessary shall be expanded to include those services necessary to treat a substance use disorder condition that is having a clinically significant impact on an Enrollee’s emotional, social, medical and/or occupational functioning. Substance use disorder services are limited to the services rendered by a physician (licensed under RCW 18.71 and RCW 18.57), a psychologist (licensed under RCW 18.83), a substance use disorder treatment program licensed for the service being provided by the Washington State Department of Social and Health Services (pursuant to RCW 70.96A), a master’s level therapist (licensed under RCW 18.225.090), an advance practice psychiatric nurse (licensed under RCW 18.79) or, in the case of non-Washington State providers, those providers meeting equivalent licensing and certification requirements established in the state where the provider’s practice is located. The severity of symptoms designates the appropriate level of care and should be determined through a thorough assessment completed by a licensed provider who recommends treatment based on medical necessity criteria. Court-ordered substance use disorder treatment shall be covered only if determined to be Medically Necessary. Preauthorization is required for outpatient, intensive outpatient, and partial hospitalization services. Preauthorization is not required for Residential Treatment and non-Emergency inpatient hospital services provided in-state. Enrollee is given two days of treatment and is then subject to medical necessity review for continued care. Enrollee or facility must notify KFHPWA within 24 hours of admission, or as soon as possible. Enrollee may request prior authorization for Residential Treatment and non-Emergency inpatient hospital services. Enrollee may contact Member PEBB_CA_2024 41